The Consumer Office

Massachusetts Department of Public Health

Office of HIV/AIDS

250 Washington Street 3rd Floor

Boston, MA 02108

STATEWIDE CONSUMER ADVISORY BOARD

SEEKING APPLICATIONS FOR NEW MEMBERSHIP

The mission of the Statewide Consumer Advisory Board (SWCAB) is to provide advice to the staff and senior management of the Massachusetts Department of Public Health (MDPH) Office of HIV/AIDS (OHA) and to work collaboratively on a range of strategies, policies and programmatic issues affecting the lives of people living with HIV/AIDS and those at risk. The SWCAB works with the OHA to achieve its three goals:

1)  To increase the number of persons at risk who know their HIV status,

2)  To decrease the number of new HIV infections, and

3)  To improve the health and quality of life of infected and high-risk uninfected persons.

The Statewide Consumer Advisory Board (SWCAB) is accepting applications for membership. In accordance with its guidelines, “… membership is drawn from people living with HIV/AIDS (PLWHA) [or the parent/guardian of a child under 21 living with HIV/AIDS] active in Consumer Advisory Boards, agency boards of directors or other HIV/AIDS-related bodies.” In addition, the SWCAB seeks to have as diverse a membership as possible so that the perspectives of all PLWHA in Massachusetts are represented.

The process of recruiting new members occurs once a year. The terms of membership is three (3) years and starts in September. Everyone must complete and mail in an application. Even if you applied last year, you must complete a new application and send it in by the deadline. Application must be received post-marked by July 31, 2013.

Meetings of the SWCAB usually take place the third Tuesday of each month from 6:00PM to 9:00PM in Boston. SWCAB members are expected to attend all scheduled SWCAB meetings, and to participate on committees or working groups.

All applicants must complete the attached form and submit two letters of reference. Applicants are selected on the basis of their own skills, experience and interests. Also, the Nomination Committee will strive to achieve a balanced representation of the demographic and geographic profile of the epidemic in Massachusetts. PLWHA who fit the membership guidelines and are interested in serving on the SWCAB are encouraged to apply.

Incomplete applications or applications received after the July 31, 2013 deadline will not be considered. Shortly after the deadline, applicants will be contacted to arrange an interview with the SWCAB Nominating Committee and the staff of the Consumer Office. This meeting will give applicants an opportunity to provide additional information about them, ask questions, and receive more information about the SWCAB.


STATEWIDE CONSUMER ADVISORY BOARD

MEMBERSHIP APPLICATION

Name (please print) / Email Address
Address
City / State / Zip Code
Phone Number (with area code) / Alternate Number (with area code)

SWCAB membership should represent the profile of HIV/AIDS in Massachusetts, including geographic and demographic representation. To assist us in the selection of a diverse group, please fill out as many of the following as you are comfortable sharing:

Gender:
Female
Male
Transgender:
Female to Male
Male to Female / Age:
Veteran: Yes No
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Portuguese Speaker
Other (please specify: / Sexual Orientation:
Bisexual
Gay
Heterosexual/Straight
Lesbian
Race:
White
American Indian or Alaska Native
Asian
Black (please check as appropriate):
African American
Sub-Saharan African
Caribbean
Native Hawaiian or Other Pacific Islander
Multiracial (please specify):
Other (please specify): / Risk Category:
Blood Transfusion / Blood Products
Injection Drug Use
Male to Female / Female to Male
Male to Male
Mother to Child
Unknown
Other (please specify):

1)  What CAB, Board of Directors, or other consumer groups are you currently serving on (including SWCAB)? Please check all that apply:

Agency/Group Type: / Agency/Group Name / How Long?
Agency CAB
Agency Board of Directors
Other Consumer Group (please specify)
Statewide CAB
Massachusetts Integrated Prevention & Care Committee (MIPCC)
Title I Planning Council

1)  What community living with HIV/AIDS best represents you? (Such as people in recovery, parent, GLBT, etc)

2)  Please state why you are interested in becoming a member of the Statewide Consumer Advisory Board (SWCAB):

4)  What special skills, experiences or perspectives would you bring to the SWCAB?

5)  If you are employed and/or belong to other community groups or have an otherwise busy schedule, would you be able to make time commitments to attend all SWCAB meetings, including working group/sub-group meetings, and do some work as needed between meetings throughout the course of your membership? Yes No

Please return the form and attach two letters of reference to:

Nomination Committee | C/O Paul B. Goulet

Department of Public Health Office of HIV/AIDS

250 Washington Street | 3rd Floor | Boston, MA 02108

Phone: 617-624-5389 | Email:

Deadline for submissions: Application must be received post-marked by July 31, 2013. Nominees for membership on the SWCAB are selected by a Nominating Committee and approved by the Department of Public Health. You will be notified by August 30, 2013 of the Department of Public Health’s decision.

Statewide Consumer Advisory Board Membership Application Page 2 of 3